Cholinergic Crisis

Overview

5 out of 5 (12 Reviews)

Credits

1.50

Pharmacology Credits

0.5

Post-Assessment Questions

7

Start Date

1 Sep 2023

Last Review Date

6 Apr 2025

Expiration Date

31 Aug 2026

Estimated Time To Finish

90 Minutes


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Activity Description

Cholinergic crisis is a potentially life-threatening medical emergency resulting from the overstimulation of nicotinic and muscarinic receptors at the neuromuscular junctions and synapses. The pathophysiology involves the inhibition of acetylcholinesterase, the enzyme responsible for acetylcholine degradation. This inhibition leads to the excessive accumulation of acetylcholine, which causes symptoms of both muscarinic and nicotinic toxicity.

Cholinergic toxicity can occur following exposure to organophosphorus compounds, such as nerve agents (eg, Sarin, Soman, and Tabun), which may be used as chemical weapons. The increasing frequency of terrorist activities and the global threat of chemical warfare heighten the risk of exposure. Additionally, the widespread availability of pesticides, particularly in agricultural communities, contributes to both unintentional and intentional exposure.

Symptoms of cholinergic toxicity include bradycardia, bradypnea, bronchorrhea, cramps, lacrimation, muscular weakness, paralysis, fasciculation, diarrhea, and blurry vision. Prompt recognition of signs and symptoms is critical for early diagnosis and the initiation of therapy, which can be lifesaving. Evaluation of cholinergic crisis includes a clinical assessment for potential exposure and plasma cholinesterase levels. Management involves atropine to counteract muscarinic effects and pralidoxime to reverse nicotinic toxicity. Supportive care, such as mechanical ventilation, may be needed for respiratory distress. Prognosis improves with prompt treatment, but delays can lead to severe complications, including respiratory failure.

This activity for healthcare professionals is designed to enhance learners' proficiency in evaluating and managing cholinergic crisis. Participants will deepen their understanding of the condition's causes, pathophysiology, and clinical presentation. The recommended evaluation and therapeutic approaches will also be discussed. Improved clinical skills will equip clinicians to collaborate effectively within an interprofessional team caring for affected individuals.


Target Audience

This activity has been designed to meet the educational needs of physicians, physician associates, nurses, pharmacists, and nurse practitioners.

Learning Objectives

At the conclusion of this activity, the learner will be better able to:

  • Identify the clinical and diagnostic features indicative of cholinergic crisis.

  • Select clinically appropriate diagnostic examinations to evaluate cholinergic toxicity.

  • Implement personalized management approaches for cholinergic toxicity.

  • Collaborate with all members of the interprofessional team, including specialists such as toxicologists and intensivists, to provide efficient, comprehensive, and coordinated care for individuals experiencing cholinergic crisis.

  • Outline the pharmacologic therapy as it applies to Cholinergic Crisis

Disclosures

StatPearls, LLC requires everyone who influences the content of an educational activity to disclose relevant financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. All relevant conflict(s) of interest have been mitigated. Hover over contributor names for financial disclosures. Others involved in planning this educational activity have no relevant financial relationships to disclose.

Commercial Support: This activity has received NO commercial support.

Continuing Education Accreditation Information

In support of improving patient care, StatPearls, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

 

Nurse Practitioners: StatPearls designates this activity for 1.50 ANCC contact hour(s), which includes 0.5 hour(s) of pharmacology. NPs should only claim credit commensurate with the extent of their participation in the activity.

Please consult your professional licensing board for information on the applicability and acceptance of continuing education credit for this activity.

Method of Participation and Credit

  1. Register for the activity.    
  2. Review the target audience, learning objectives, and disclosure information.
  3. Study the educational content of the enduring material.
  4. Choose the best answer to each activity test question. To receive credit and a certificate, you must pass the test questions with a minimum score of 100%.
  5. Complete the post-activity assessment survey.

If you have concerns regarding the CE/CME system, please contact support@statpearls.com.

Disclaimer

This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Faculty may discuss investigational products or off-label uses of products regulated by the FDA. Readers should verify all information before employing any therapies described in this educational activity.

The information provided for this activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. The information presented does not necessarily reflect the views of StatPearls or any commercial supporters of educational activities on statpearls.com. StatPearls expressly disclaims responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through a participant's misunderstanding of the content.

Unapproved Uses of Drugs/Devices: In accordance with FDA requirements, the audience is advised that information presented in this continuing education activity may contain references to unlabeled or unapproved uses of drugs or devices. Please refer to the FDA-approved package insert for each drug/device for full prescribing/utilization information.

Cancellation Policy: Please see the cancellation policy. StatPearls, LLC reserves the right to cancel any course due to unforeseen circumstances.

 

 
 

Reviews

Larry E. on 4/3/2023

Kenneth K. on 10/4/2023

Ehsan q. on 11/2/2023

Jamey E. on 1/18/2024

brian w. on 2/3/2024

John L. on 2/20/2024

Jessica C. on 4/2/2024

James M. on 4/16/2024

Tran P. on 5/1/2024

Bogdana T. on 7/21/2024

maureen c. on 8/3/2024

Oliver G. on 1/12/2025

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Unlimited Nurse Practitioner CE

Stay up to date on the latest medical knowledge with 6720 CE activities. In these online self-assessment activities, read our reference articles and test your knowledge with more than 7991 hours of CE.

Single Activity

Take this single activity

$73.50 1 activity

6 Month Unlimited Nurse Practitioner CE

Access to all the Unlimited Nurse Practitioner CE activities in all specialties.

$299 per half year per user

1 Year Unlimited Nurse Practitioner CE

Access to all the Unlimited Nurse Practitioner CE activities in all specialties.

$479 per 1 year per user